Addyi (flibanserin tablets) — Cigna

Initial criteria

• Patient is premenopausal; AND
• Patient’s symptoms of HSDD/FSIAD have persisted for a minimum of 6 months; AND
• Patient has had normal sexual desire in the past, prior to the diagnosis of HSDD/FSIAD; AND
• Patient does not have a diagnosis of depression; AND
• Other known causes of HSDD/FSIAD (e.g., co-existing medical or psychiatric conditions, problems within a relationship, effects of medications, or drug abuse) have been ruled out by the prescriber; AND
• The prescriber has counseled the patient regarding the interaction with alcohol and Addyi, and the increased risk of hypotension and syncope.

Reauthorization criteria

• Patient is premenopausal; AND
• The prescriber confirms that since initiating Addyi therapy, the patient reports a significant improvement in sexual desire and/or a decrease in sexual distress; AND
• Patient has not reported any serious or concerning adverse events (e.g., hypotension, syncope, dizziness) while taking Addyi.

Approval duration

Initial: 8 weeks; Reauth: 6 months